Impactful Residential Care, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

IMPACTFUL RESIDENTIAL CARE, LLC

Practice address

27 Seavey St
Westbrook, ME 04092-4336

Phone

(571) 278-6103

NPI assigned

Mar 24, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Assumpta Mukabutera, MPH, PH.D

Title

Ceo

Phone

(207) 310-3101

Specialties & licenses 1

Addresses

Other names 1

• IRC, LLC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1134879125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8057",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041048057",
            "telephone_number": "207-310-3101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 SEAVEY ST",
            "city": "WESTBROOK",
            "state": "ME",
            "postal_code": "040924336",
            "telephone_number": "571-278-6103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACTFUL RESIDENTIAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "MUKABUTERA",
        "authorized_official_first_name": "ASSUMPTA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "207-310-3101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MPH, PH.D"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IRC, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michelle M Huntley, RD, CDE
• Ellen Marie Hurd, LCSW
• Sidney Hurst
• I Care Home Care
• Corneliu Mircea Ilea
• Katharine Ingwersen, LCSW
• Integrative Body Network
• Mackinleigh Isherwood, PHARMD
• Diane Jaeckel, LCSW
• Diyar Jebur

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Westbrook, ME
• Providers in Westbrook, ME by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.